RECORDS-OFFICER-DESIGNATION-2025.PDF

RECORDS MANAGEMENT BRANCH 
1901 West Madison Street • Phoenix, Arizona 85009 
(602) 926-3720 • records@azlibrary.gov • www.azlibrary.gov
Revised 10/2024 
ARIZONA STATE LIBRARY, ARCHIVES, AND PUBLIC RECORDS 
A DIVISION OF THE ARIZONA SECRETARY OF STATE 
AGENCY RECORDS OFFICER 
DESIGNATION FORM 
Pursuant to ARS §41-151.14, the head of each state and local agency shall designate an individual within the agency to manage the 
records management program of the agency. The agency shall reconfirm the identity of this individual to the state library every 
other year. The designated individual must be at a level of management sufficient to direct the records management program in an 
efficient and effective manner and shall act as a coordinator and liaison for the agency with the state library. 
Instructions: Complete this form to inform the State Library of any changes regarding your agency records officer. This includes new 
designations or updates to contact information. Once filled out, kindly return the signed form to records@azlibrary.gov.  
ACTION:     ☐ New Designation      
☐Update to Existing Designation
Agency Name: 
Division, Department or Unit Name: 
Agency Records Officer Name: 
Title: 
Mailing Address: 
City: 
State: 
Zip: 
E-mail Address: 
Telephone: 
Does the Records Officer have authority to set policy or procedures?     ☐ Yes 
☐No
I, _________________________, do hereby designate the above individual as the listed agency’s records officer. 
Agency Head or Designee 
Head of Agency (or Designee) Signature: 
Date: 
Head of Agency (or Designee) Title: 
For LAPR Use Only: 
Certified By: ______________________________         Date: __________________ 
 Records Analyst or Administrator 
This designation expires on or before: ____________________. 
Maricopa County
Information Governance
Cynthia Zbiegien
Director Information Governance
301 W. Jefferson
Phoenix
AZ
85003
cynthia.zbiegien@maricopa.gov
602-228-4200
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